Orthodontic Expansion & Airway – What You Need To Know
As a Board-Certified Orthodontic Specialist, one of the most important clinical decisions I make is determining when Phase I Palatal Expansion is truly indicated – and when it is not. Expansion has become a popular topic in orthodontics, often discussed in relation to airway health, crowding, and smile aesthetics. While these benefits can be real, expansion should never be performed simply to create space for teeth. The goal is not to mask a dental issue, but to correctly diagnose – and treat – the underlying skeletal or functional problem.
What Palatal Expansion Treats
Palatal expansion is used to address skeletal transverse deficiencies, where the upper jaw (maxilla) is too narrow relative to the lower jaw or facial structures. In appropriately diagnosed patients, palate expansion can:
- Improve jaw harmony
- Create space for natural tooth eruption
- Support oral function and nasal airway volume
- Contribute to balanced facial development
Not every child with crowding or breathing concerns needs expansion, which is why expert diagnosis is essential.
True Skeletal Expansion vs. Dental Expansion
True Skeletal Expansion applies orthopedic forces directly to the maxillary bone, not just the teeth. In growing children – typically between ages 7 and 12, before fusion of the mid-palatal suture – a fixed expander with acrylic (plastic) palatal pads allows controlled widening of the upper jaw. This is the type of expander that Dr. Welsh utilizes.
Dental Expansion, by contrast, moves teeth outward within the existing bone. While this may temporarily align teeth, it often lacks stability and can increase the risk of relapse or gum recession. Metal-only or removable expanders tend to produce primarily dental effects rather than a true skeletal change.
Why Timing Matters
Why Age 7? As children mature, the mid-palatal suture gradually fuses. Expansion performed too late – or without proper evaluation – may be less effective or require more invasive intervention. Phase I Orthodontics is therefore guided not by age alone, but by growth patterns, skeletal relationships, airway health, and functional development.
Stability Through Skeletal Correction
One of the greatest advantages of true skeletal expansion is long-term stability. After expansion, the appliance remains in place while new bone forms between the two halves of the upper jaw. This biologic process takes 6 months and allows the maxilla (palate / upper jaw) to maintain its new width, providing a stable foundation for future tooth alignment and reducing the likelihood of alignment later in life.
When Expansion Is Not Enough
In some cases, a narrow arch is influenced by factors beyond Orthodontics, including chronic mouth breathing, nasal obstruction, enlarged tonsils or adenoids, or sleep-disordered breathing. When these concerns are present, collaboration with an ENT or other medical specialists may be necessary. Recognizing when to involve other professionals is a critical part of responsible orthodontic care. Dr. Welsh is here to quarterback your team of Dental & Medical professionals to provide your child with truly comprehensive care.
A Thoughtful, Interdisciplinary Approach
At Bucks County Orthodontics, we focus on fixing the problem – not forcing a solution. If Phase I expansion is indicated, Dr. Welsh uses appliances designed to achieve true skeletal change comfortably and predictably. If it is not, he monitors growth and development through our BCO Kids Club, ensuring treatment begins at the right time.
Every child deserves a precise diagnosis and a well-coordinated plan. We invite you to schedule a complimentary consultation to determine the best path forward for your child. We look forward to welcoming you and your family!
Free Consult includes Dr. Welsh’s comprehensive exam, diagnosis, 3D x-ray, 3D digital scan, explanation of all treatment options and flexible financial plans. No referral needed. Most insurances accepted.